Provider First Line Business Practice Location Address:
1670 E 120TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-338-1230
Provider Business Practice Location Address Fax Number:
310-223-5962
Provider Enumeration Date:
02/14/2017